ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Initial Endodontic Treatment Has Similar Long-Term Survival Rate Compared to Single-Tooth Implants
Clinical Question In patients with periodontally sound teeth that have pulpal and/or periradicular pathosis, does initial root canal therapy, compared to extraction and replacement of the missing tooth with an implant, result in better clinical outcomes?
Clinical Bottom Line An adequately restored, endodontically treated tooth and single implant supported restoration have similar long-term survival rates (94-97%).
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18661795Torabinejad/200824 endodontic studies and 46 dental implant studies on treatment outcome.Systematic Review and Meta-Analysis
Key resultsClinical outcomes were grouped into three follow-up intervals: two to four years, four to six years and more than six years. There was a mean increase of 3-11% in success rate in implants compared to initial root canal treatments for the follow-up intervals. Weighted long-term survival rates were 0.96 (0.95, 0.98) for implants (95%CI) and 0.94 (0.92, 0.96) for initial root canal treatments (95%CI).
Evidence Search Endodontic therapy implants outcome Filter: systematic review
Comments on
The Evidence
A large number of studies were included in this systematic review, However, the majority were case series analyses. The main sources for heterogeneity among these studies were differences in definition of success or failure as well as in the interpretation of treatment complications, when these occurred.
Applicability The results are applicable to patients with good periodontal condition and pulp pathosis when a decision is to be made on the treatment approach. It is stated that sufficiently restored endodontically treated teeth have similar survival rates compared to single-tooth implants.
Specialty/Discipline (Endodontics) (General Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords dental implants single tooth, root canal therapy, decision making, treatment outcome
ID# 2307
Date of submission: 08/08/2012spacer
E-mail chrepa@uthscsa.edu
Author Vanessa Chrepa, BDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Fabricio Teixeira, DDS, MS, PhD
Faculty mentor/Co-author e-mail fabricio-teixeira@uiowa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
by Vanessa Chrepa (San Antonio, TX) on 09/17/2012
Wound healing of apical lesions after non-surgical root canal therapy follows the general principles of wound healing of connective tissues elsewhere in the body: formation of fibrovascular granulation tissue, macrophage-mediated debridement, and finally regeneration and/or repair of the wounded tissue. A hallmark of periapical healing is a shift in cytokine profile favoring anti-inflammatory cytokines such as IL-10, followed by a shift in osteoclast/osteoblast balance. Activated osteoblasts initiate the process of mineralization of the debrided fibrous connective tissue. In addition, the restoration of damaged periapical tissues may involve the recruitment of progenitor/stem cells from the periodontal ligament, endosteum, bone marrow and possibly periosteum to differentiate into PDL fibroblasts, cementoblast-like cells and osteoblasts.PMID: 21718337, PMID: 19410070 Bone healing around dental implants is based on the following successive phases: osteoconduction, de novo bone formation and bone remodeling. Concisely, these phases include inflammation and necrosis, blood clotting organization and replacement, chemotaxis of pluripotential mesenchymal cells into the peri-implant site and adhesion on implant surface, neoangiogenesis, as well as differentiation of these cells into osteoclasts and osteoblasts.PMID: 12959168, PMID: 18406338
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